BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

These findings could contribute to the higher rate of cardiovascular events in smokers.

These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.

Cardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.

itral valve prolapse (MVP) is the most commonly diagnosed valvular heart disease, especially in the young, and affects 5% of the community. 1 Although it is reported that MVP has a good prognosis and a low incidence of complications, 2 it is obvious that even a rare complication will affect many individuals due to the high incidence of MVP in the general population. 3 However, some reports point out that these complications are not as rare as was thought, 4,5 the main entities being endocarditis, cerebrovascular accidents, sudden death, ventricular tachycardia and ventricular fibrillation. Arrhythmia and sudden death are significant complications in MVP cases; a 0.5% incidence of sudden death has been reported in different MVP studies 3,6 and it is suggested that the underlying mechanism of the sudden death is arrhythmogenic. It was also claimed that the prolonged QT intervals in MVP cases could be related to arrhythmia and sudden death. 7,8 Furthermore, there are studies that found that, instead of a prolonged QT interval increase, intrinsic QT dispersion can be related to arrhythmia in these cases. 9,10 In the present study, we aimed to determine the relationship between intrinsic QT dispersion and ventricular Japanese Circulation Journal Vol.63, December 1999 arrhythmias and sudden death in young individuals suffering from uncomplicated isolated MVP (IMVP). In this respect, cases without leaflet thickening (≥5 mm), severe mitral regurgitation or left ventricular systolic dysfunction were included in the study. Although a few reports have concentrated on the clinical significance of MVP accompanying tricuspid valve prolapse (TVP), the clinical significance of TVP and its relation to the arrhythmias of MVP has not yet been clearly documented. Therefore, we excluded MVP cases with accompanying TVP after beginning the study. Our main aim was to investigate the incidence and distribution of ventricular arrhythmias, according to their severity and relation to the QT interval, and to the dispersion of repolarization in uncomplicated IMVP. Methods Study GroupsThe current study was carried out in the Department of Cardiology, Faculty of Medicine, Dicle University between May 1996 and April 1998. We registered 91 individuals who underwent echocardiographic examination and were diagnosed as MVP; the group included 33 cases with accompanying TVP. Those patients who had disorders such as ischemic or rheumatic heart disease, systemic and/or pulmonary hypertension, diabetes mellitus, hyperthyroidism, stenotic valvular heart disease, congenital heart diseases, severe mitral regurgitation (>3 cm 2 regurgitant jet length in color flow mapping), or severe left ventricular dysfunction Jpn Circ J 1999; 63: 929 -933 (Received November 16, 1998; revised manuscript received July 16, 1999; accepted July 23, 1999 Complications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite t...